Managing women with cervical cancer symptoms: Cervical One-Stop Assessment Clinic

Women with symptoms suggestive of cervical cancer require prompt specialist gynaecological review with access to diagnostic testing. A Cervical One-Stop Assessment Clinic (COSAC) was established at Cork University Maternity Hospital in 2021. This retrospective review evaluates the first three years of this service.

Anonymised data from all attendees of the between September 2021 and September 2024 were collected, including referral indication, cervical cancer risk factors, examination findings, investigations, and onward referrals. Descriptive analysis was performed using Microsoft Excel.

During the review period, 1714 COSAC appointments were offered based on referral details and 1522 of these women attended (88.9%). The mean age was 39 years. Most referrals were for abnormal cervical appearance (812, 53.5%) or post-coital bleeding (408, 26.8%). The majority of attendees were up to date with HPV screening and had tested negative (1238, 90.7%). Most attendees had a normal examination and did not require biopsy (1155, 76.2%). Of the 185 (12.2%) biopsied, most results were benign, including metaplasia (133, 71.9%) and cervicitis (42, 22.7%). Pre-cancer cervical intraepithelial neoplasia was identified in three women (3/1522), two with low grade changes. Advanced squamous cell carcinoma was confirmed in two women. Both were over 35, multiparous and overdue for screening with no prior colposcopy.

COSAC clinics provide specialist care for symptomatic women and help maintain colposcopy capacity for those with an abnormal screening result. They are low resource, high impact services which could be considered a useful adjunct for implementation in gynaecology units nationally and internationally.